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Prospective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children.

CONTEXT: Community-acquired, methicillin-resistant (CA-MRSA) infections in children are increasing in frequency for unknown reasons. OBJECTIVES: To compare the presence of risk factors for methicillin resistance between patients with CA-MRSA and community-acquired methicillin-susceptible (CA-MSSA) infection and to compare the presence of risk factors among household contacts of the patients from both groups. To compare the demographic and clinical characteristics between children with CA-MRSA and CA-MSSA infection. DESIGN: Prospective observational study conducted between February 2, 2000 and November 14, 2000, excluding the month of May and the period between September 2 and October 15. SETTING AND PATIENTS: Texas Children's Hospital, Houston, TX; inpatients and outpatients with community-acquired infection. MAIN OUTCOME MEASURES: Proportion of MRSA among all community-acquired infections. The presence of risk factors associated with methicillin resistance among patients, and their household contacts, with CA-MRSA and CA-MSSA. RESULTS: The monthly rates of methicillin resistance of varied between 35 and 51%. CA-MSSA isolates were associated with deep-seated infections significantly more often (30%) than CA-MRSA isolates (11%; P= 0.01). CA-MRSA isolates were generally susceptible to clindamycin and trimethoprim-sulfamethoxazole and resistant to erythromycin. There were no significant differences in the exposure to risk factors between children with CA-MRSA and CA-MSSA infection. No significant risk factors for CA-MRSA were identified among household contacts. CONCLUSIONS: MRSA is an established, community-acquired pathogen in our area. This necessitates a change in empiric therapy of infections suspected to be caused by.

Adolescent↗

Testosterone-antibiotic effectiveness on staphylococcus aureus infected rats.

(1) Male castrated rats (testosterone-free) inoculated intraperitoneally with Staph. aureus showed severe damage in their internal organs as determined by pathological examination of the killed animals. (2) Penicillin-G, oxytetracycline and chloramphenicol treatment 24 h after injection markedly decreased the extent of damage. (3) Pretreatment of castrated rats with testosterone propionate for 3 successive days before infection had a protective influence on the internal organs. (4) Testosterone-injected rats when treated with different antibiotics, showed a clear synergistic action with penicillin-G and oxytetracycline but not chloramphenicol.

Animals↗

Staphylococcus aureus infective endocarditis: diagnosis and management guidelines.

S. aureus infective endocarditis (SAIE) is a serious infection associated with considerable morbidity and mortality. There is evidence that the incidence of SAIE is increasing. As its clinical features are non-specific, SAIE must be suspected in every case of S. aureus bacteraemia, whether it is associated with an obvious source or not. The optimal antimicrobial agent(s) and duration of treatment for SAIE are currently not known, but on the basis of present evidence, a minimum of 2 weeks of antimicrobial therapy is recommended for 'right-sided' SAIE, a minimum of 4 weeks for uncomplicated 'left-sided' SAIE, and a minimum of 6 weeks for complicated 'leftsided' or prosthetic valve SAIE. Although there is no evidence to suggest that combination therapy with a cell-wall active agent (e.g. flucloxacillin) and an aminoglycoside decreases mortality in SAIE, combination therapy should be considered during the initial 3-5 days of therapy as it can shorten the duration of bacteraemia. In complicated or prosthetic valve SAIE, early and close liaison with cardiology and cardiothoracic surgery services is essential. Rapid identification and susceptibility testing of the infecting organism are important in determining the choice of definitive antimicrobial therapy.

Anti-Bacterial Agents↗

Detection of Staphylococcus aureus infection by enzyme-linked immunosorbent assay and immunoblotting, using high molecular weight staphylococcal proteins.

Two high molecular weight staphylococcal proteins, fibronectin-binding protein and a Mr 200,000 protein, were investigated as antigens for serodiagnosis of staphylococcal infections. Sera from patients with staphylococcal infections and from controls were subjected to immunoblot analysis with staphylococcal lysate proteins to identify staphylococcal antigens to which patients with staphylococcal infections specifically exhibited antibodies. One such protein was found in the Mr 200,000 region. This protein was purified and used as antigen in ELISA and compared with other antigens, namely fibronectin-binding protein(s) (FNBP, Mr 185,000), alpha-toxin and teichoic acid. Sera from patients with staphylococcal infections contained antibodies to the high molecular weight proteins in higher titers than sera from patients with non-staphylococcal infections or healthy subjects. Based on their amino-acid compositions and different abilities to bind fibronectin it was concluded that the Mr 200,000 protein and FNBP were not identical.

Adolescent↗

Serological response to toxic shock syndrome toxin in Staphylococcus aureus infected patients and healthy controls.

The prevalence of antibodies to Toxic Shock Syndrome Toxin (TSST-1) in a Swedish healthy control population was investigated using an enzyme-linked immunosorbent assay (ELISA). 88% of the control group above the age of 10 showed positive antibody levels as compared to 31% of those who were under 10 years old. These results indicate a very common normal exposure to TSST-1 during early life and also identify the small risk-group of potential TSS-patients. Patients with S. aureus endocarditis and septicemia showed slightly higher antibody levels as compared to the controls (p less than 0.05). The difference was in part due to 3/4 septicemia patients, infected with TSST-1 producing strains, who showed very high antibody levels. None of these 4 patients developed any signs of TSS. 5/5 menstrual associated TSS-patients were negative in the ELISA in serial serum samples as were 3/5 non-menstrual associated TSS-patients. The TSST-1 ELISA is proposed for identifying chiefly young women at risk of acquiring menstrual related Toxic Shock Syndrome.

Antibodies, Bacterial↗

[Two cases of methicillin-resistant Staphylococcus aureus infection].

We have experienced 2 cases of MRSA infection. Case 1: A 16 month-old girl, whose underlying disease was VAHS, had chronic sinusitis. MRSA was isolated from the blood and rhinorrhea. Her sinusitis was very intractable and it was difficult to eradicate MRSA from the nare. Case 2: A 6-months-old girl was admitted to our hospital with urinary tract infection. She had an ectopic uretelocele. Partial nephrectomy and uretectomy was performed. Retroperitoneal and intraperitoneal abscess had recurred three times during 17 months after the first operation. This abscess was slowly progressive and MRSA was very difficult to eradicate. These 2 cases showed characteristics of MRSA infection.

Anti-Bacterial Agents↗

Antibody response to fibronectin-binding adhesin FnbpA in patients with Staphylococcus aureus infections.

We have analyzed antibody reactivity to a fibronectin-binding microbial surface component that recognizes adhesive matrix molecules (MSCRAMM) in blood plasma collected from patients with staphylococcal infections. All patients had elevated levels of anti-MSCRAMM antibodies compared to those of young children who, presumably, had not been exposed to staphylococcal infections. The anti-MSCRAMM antibodies preferentially reacted with the ligand-binding repeat domain of the adhesin. However, these antibodies did not inhibit fibronectin binding. Essentially, all patients had antibodies which specifically recognized the fibronectin-MSCRAMM complex but not the isolated components. Epitopes recognized by these anti-ligand-induced binding sites antibodies were found in each repeat unit of the MSCRAMM. These results demonstrate that staphylococci have bound fibronectin some time during infection and that each repeat unit in the MSCRAMM can engage in ligand binding. Furthermore, our previously proposed model, suggesting that an unordered structure in the MSCRAMM undergoes a conformational change upon ligand binding (K. House-Pompeo, Y. Xu, D. Joh, P. Speziale, and M. Höök, J. Biol. Chem. 271:1379-1384, 1996), is presumably operational in patients during infections.

Adhesins, Bacterial↗